ACSM CEP ACTUAL EXAMS SCRIPT QUESTIONS
AND ANSWERS SURE A+
✔✔Frank-Starling Mechanism - ✔✔Greater EDV results in a more forceful contraction
Due to stretch of ventricles
✔✔cardiovascular regulation (extrinsic) - ✔✔parasympathetic nervous system- cranial
nerve X (vagus nerve) release ACH at SA node; causes K+ channels to open K+ exits
cell (hyperpolarization) decrease HR and contractility below 100
Sympathetic nervous system- release norepinephrine causes CA+ to enter cell
(depolarize) increase HR and contractility
Endocrine system- adrenal gland secretes catecholamines (E;NE) increase HR and
contractility
✔✔cardiorespiratory fitness - ✔✔The ability of the circulatory and respiratory systems to
supply oxygen-rich blood to skeletal muscles during sustained physical activity. the
ability to perform large muscle, dynamic, moderate to vigorous-intensity exercise for
prolonged periods of time
✔✔Mets - ✔✔the equivalent of workload/ exertion
the measure of exercise intensity based on oxygen consumption resting 3.5 ml/kg/min 1
met
relative/3.5 = mets
,✔✔RPE - ✔✔rating of perceived exertion how hard an indivudal is working
11-14 moderate intensity
over 17 vigorous
✔✔VO2 max - ✔✔the maximum amount of oxygen the body can take in and use during
exercise. measurement of CRF
✔✔Myocardial supply and demand altered - ✔✔Cardiovascular diseases (CAD)
physical activity/exertion
Beta Blockers
Nitroglycerin
✔✔Informed consent - ✔✔ensure the participant knows and understands the purpose
and risk associated with the test or exercise program. should be verbally explained and
give the patient the opportunity to ask questions or clarify if needed. responsibilities of
the patient. if the test is needed for other factors than diagnosis or ex Rx must be
indicated during informed consent. communicate to patient that emergency procedures,
equipment, and trained qualified staff are on site
✔✔Evaluation before exercise test - ✔✔medications, past procedures or surgical
interventions, medical diagnoses, previous physical examination findings, laboratory
findings, family hx, work history(level of exertion required of current job if applicable,
exercise history. S&S with exertion of PA or exercise, other habits(tobacco, alcohol,
illicit drug use, caffeine)
✔✔Preparticipation Health Screening w/o professional - ✔✔2014 PAR Q+
✔✔Preparticipation health screening (risk stratification) - ✔✔determine overall health/
medical supervision needed/ likelihood of events or symptoms of CVD
✔✔Risk Stratification - ✔✔# of cardiovascular risk factors, presence of S&S known CV,
metabolic, and pulmonary disease. individuals current level of PA, desired ex intensity.
need for medical clearance of exercise test before engaging in ex or CR. (symptoms or
new changes to health) no longer automatically refers individuals with pulmonary
disease for medical clearance
✔✔Risk Factor for CVD - ✔✔age 45(M) 55(F)
family history- 1st gen
cigarette smoker- current smoker, quit within last 6 months
physical inactivity-does not participate in moderate PA 3 days a week for at least 30 min
3 months
BMI- greater than 30
waist circumference- 102 cm(40in M) 88cm(35 in F)
HTN- 140/90 2 separate readings or on hypertensive medications
, LDL- greater than or equal 130
HDL(negative) less than 40
Diabetes
HDL(positive) equal or greater than 60
✔✔when is medical clearance recommended/required? - ✔✔any S&S suggestive of CV,
metabolic, renal disease (angina equivalents, SOB with mild exertion, dizziness or
syncope, orthopnea(SOB at rest relieved when sitting or standing upright), ankle
edema, palpitation or tachycardia, intermittent claudication, known heart murmur,
unusual SOB with usual activities and does not participate in regular exercise
✔✔High risk for exercise participation - ✔✔Presence of complex ventricular
dysrhythmias during exercise testing or recovery, presence of angina or other significant
symptoms at low levels of exertion. high level of silent ischemia (ST-segment
depression >2mm from baseline during exercise testing and recovery. abnormal
hemodynamic with ex testing. resting EF less than 40. history of cardiac arrest or
sudden death. complex dysrhythmias at rest, complicated MI, or revascularization
procedure. CHF, clinical depression, S&S
✔✔purpose of preparticipation health screening - ✔✔identify individuals who are at risk
for adverse exercise related CV events. identify medical observation needed
SAFETY OF PATIENT
✔✔Absolute contraindications to start exercise testing - ✔✔-Recent change in EKG
suggesting ischemia, myocardial infarction (w/in 2 days), or other acute cardiac event
-Unstable angina
Acute MI (within2 days)
-Uncontrolled cardiac dysrhythmias with hemodynamic compromise
-Symptomatic severe aortic stenosis
-Uncontrolled symptomatic heart failure
-Acute pulmonary embolism, infarction, DVT
New onset LBBB
-Acute myocarditis, endocarditis, pericarditis
acute aortic dissection
physical disability precluding safe and adequate testing
✔✔Relative indications to start exercise testing - ✔✔Known obstructive left main
coronary artery stenosis Moderate to severe aortic stenosis with uncertain relationship
to symptoms
Tachyarrhythmias with uncontrolled ventricular rates Acquired advanced or complete
heart block Recent stroke or transient ischemia attack
Mental impairment with limited ability to cooperate Resting hypertension with systolic
>200 mm Hg or diastolic >110 mm Hg
Uncorrected medical conditions, such as significant anemia, important electrolyte
imbalance, and hyperthyroidism
AND ANSWERS SURE A+
✔✔Frank-Starling Mechanism - ✔✔Greater EDV results in a more forceful contraction
Due to stretch of ventricles
✔✔cardiovascular regulation (extrinsic) - ✔✔parasympathetic nervous system- cranial
nerve X (vagus nerve) release ACH at SA node; causes K+ channels to open K+ exits
cell (hyperpolarization) decrease HR and contractility below 100
Sympathetic nervous system- release norepinephrine causes CA+ to enter cell
(depolarize) increase HR and contractility
Endocrine system- adrenal gland secretes catecholamines (E;NE) increase HR and
contractility
✔✔cardiorespiratory fitness - ✔✔The ability of the circulatory and respiratory systems to
supply oxygen-rich blood to skeletal muscles during sustained physical activity. the
ability to perform large muscle, dynamic, moderate to vigorous-intensity exercise for
prolonged periods of time
✔✔Mets - ✔✔the equivalent of workload/ exertion
the measure of exercise intensity based on oxygen consumption resting 3.5 ml/kg/min 1
met
relative/3.5 = mets
,✔✔RPE - ✔✔rating of perceived exertion how hard an indivudal is working
11-14 moderate intensity
over 17 vigorous
✔✔VO2 max - ✔✔the maximum amount of oxygen the body can take in and use during
exercise. measurement of CRF
✔✔Myocardial supply and demand altered - ✔✔Cardiovascular diseases (CAD)
physical activity/exertion
Beta Blockers
Nitroglycerin
✔✔Informed consent - ✔✔ensure the participant knows and understands the purpose
and risk associated with the test or exercise program. should be verbally explained and
give the patient the opportunity to ask questions or clarify if needed. responsibilities of
the patient. if the test is needed for other factors than diagnosis or ex Rx must be
indicated during informed consent. communicate to patient that emergency procedures,
equipment, and trained qualified staff are on site
✔✔Evaluation before exercise test - ✔✔medications, past procedures or surgical
interventions, medical diagnoses, previous physical examination findings, laboratory
findings, family hx, work history(level of exertion required of current job if applicable,
exercise history. S&S with exertion of PA or exercise, other habits(tobacco, alcohol,
illicit drug use, caffeine)
✔✔Preparticipation Health Screening w/o professional - ✔✔2014 PAR Q+
✔✔Preparticipation health screening (risk stratification) - ✔✔determine overall health/
medical supervision needed/ likelihood of events or symptoms of CVD
✔✔Risk Stratification - ✔✔# of cardiovascular risk factors, presence of S&S known CV,
metabolic, and pulmonary disease. individuals current level of PA, desired ex intensity.
need for medical clearance of exercise test before engaging in ex or CR. (symptoms or
new changes to health) no longer automatically refers individuals with pulmonary
disease for medical clearance
✔✔Risk Factor for CVD - ✔✔age 45(M) 55(F)
family history- 1st gen
cigarette smoker- current smoker, quit within last 6 months
physical inactivity-does not participate in moderate PA 3 days a week for at least 30 min
3 months
BMI- greater than 30
waist circumference- 102 cm(40in M) 88cm(35 in F)
HTN- 140/90 2 separate readings or on hypertensive medications
, LDL- greater than or equal 130
HDL(negative) less than 40
Diabetes
HDL(positive) equal or greater than 60
✔✔when is medical clearance recommended/required? - ✔✔any S&S suggestive of CV,
metabolic, renal disease (angina equivalents, SOB with mild exertion, dizziness or
syncope, orthopnea(SOB at rest relieved when sitting or standing upright), ankle
edema, palpitation or tachycardia, intermittent claudication, known heart murmur,
unusual SOB with usual activities and does not participate in regular exercise
✔✔High risk for exercise participation - ✔✔Presence of complex ventricular
dysrhythmias during exercise testing or recovery, presence of angina or other significant
symptoms at low levels of exertion. high level of silent ischemia (ST-segment
depression >2mm from baseline during exercise testing and recovery. abnormal
hemodynamic with ex testing. resting EF less than 40. history of cardiac arrest or
sudden death. complex dysrhythmias at rest, complicated MI, or revascularization
procedure. CHF, clinical depression, S&S
✔✔purpose of preparticipation health screening - ✔✔identify individuals who are at risk
for adverse exercise related CV events. identify medical observation needed
SAFETY OF PATIENT
✔✔Absolute contraindications to start exercise testing - ✔✔-Recent change in EKG
suggesting ischemia, myocardial infarction (w/in 2 days), or other acute cardiac event
-Unstable angina
Acute MI (within2 days)
-Uncontrolled cardiac dysrhythmias with hemodynamic compromise
-Symptomatic severe aortic stenosis
-Uncontrolled symptomatic heart failure
-Acute pulmonary embolism, infarction, DVT
New onset LBBB
-Acute myocarditis, endocarditis, pericarditis
acute aortic dissection
physical disability precluding safe and adequate testing
✔✔Relative indications to start exercise testing - ✔✔Known obstructive left main
coronary artery stenosis Moderate to severe aortic stenosis with uncertain relationship
to symptoms
Tachyarrhythmias with uncontrolled ventricular rates Acquired advanced or complete
heart block Recent stroke or transient ischemia attack
Mental impairment with limited ability to cooperate Resting hypertension with systolic
>200 mm Hg or diastolic >110 mm Hg
Uncorrected medical conditions, such as significant anemia, important electrolyte
imbalance, and hyperthyroidism
